Related Experiment Video
Updated: Jun 4, 2025
Simulator Training for Endovascular Neurosurgery
Published on: May 6, 2020
Feasibility and Safety of Double-Wire Technique for Microcatheter Navigation Beyond Tortuous Internal Carotid Siphon:
Michiyasu Fuga1, Toshihiro Ishibashi1, Issei Kan1
1Department of Neurosurgery, The Jikei University School of Medicine, Tokyo, Japan.
Background:
Severe vessel tortuosity may prevent a microcatheter from reaching a distal vessel. However, the double-wire technique (DWT) may facilitate the procedure. The present study evaluated the feasibility and safety of guiding a 0.027-inch microcatheter into a distal vessel beyond the tortuous internal carotid siphon (ICS) using the DWT.
Methods:
We retrospectively reviewed 61 consecutive unruptured anterior circulation aneurysms in 61 patients who underwent treatment using flow diverter or intrasaccular flow disruption with a 0.027-inch microcatheter at our institution between October 2021 and August 2024. The DWT was used for patients in whom difficulties were encountered in advancing the microcatheter beyond the ICS with a single wire. Patients were divided into 2 groups, those who required the DWT (DWT group) and those who did not (non-DWT group). To investigate whether DWT use was associated with the degree of tortuosity of the ICS, a propensity score-matched analysis was used to control for background factors.
Results:
Ultimately, 11 (18.0%) used DWT to guide a 0.027-inch microcatheter into the distal vessel of the ICS, achieving 100% success rate. After matching, the radius of ICS was significantly smaller in the DWT group than in the non-DWT group (2.7 mm vs. 3.7 mm, P = 0.039). No significant difference in the complication rate was found between the 2 groups.
Conclusions:
Although a 0.027-inch microcatheter is difficult to guide beyond a tortuous ICS to a distal internal carotid artery using only a single wire, the application of the DWT may allow the catheter to be guided without increased complications.
